| 1. |
- Östgaard, Hans-Christian, 1948, et al.
(author)
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Femoral alignment of the Charnley stem: a randomized trial comparing the original with the new instrumentation in 123 hips.
- 2001
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In: Acta orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 72:3, s. 228-32
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Journal article (peer-reviewed)abstract
- Deficient cement mantles are associated with aseptic loosening of the stem component of total hip replacement. In a former study of 206 Charnley stems, we found high frequencies of stem malalignment, especially on the lateral view, consequently resulting in a high percentage of low cement mantle grading. If the "true" lateral radiographic projection is not used, there is a risk that the frequency of mantle defects is underestimated. A logistic regression analysis showed a high correlation between low cement mantle grading and stem loosening after a mean follow-up of 10 years. The new Charnley instrumentation was introduced in 1994 and we started a randomized trial including 123 prostheses to determine whether the new instrumentation improved the position of the stem in both the AP and lateral planes. Postoperative radiographs revealed a significant change in AP positioning-i.e., from a high percentage of varus with the original method to valgus with the new instrumentation. However, there was no difference on the lateral view, with a persisting high frequency of stems with implant-inner cortex contact resulting in high percentages of low cement-mantle grading in both systems. If this deficiency, in a long-term perspective, is associated with aseptic loosening, as many authors have claimed, the manufacturers should address the problem.
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| 2. |
- Elden, Helen, 1959, et al.
(author)
-
Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture
- 2008
-
In: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:13, s. 1655-68
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate whether acupuncture has a greater treatment effect than non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. DESIGN: Randomised double-blinded controlled trial. SETTING: East Hospital, Gothenburg, and 25 antenatal primary care units in the region of Västra Götaland, Sweden. POPULATION: A total of 115 pregnant women with a clinical diagnosis of PGP who scored > or =50 on a 100-mm visual analogue scale (VAS). METHOD: Women were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for 8 weeks. MAIN OUTCOME MEASURES: Main outcome measure was pain. Secondary outcomes were frequency of sick leave, functional status, discomfort of PGP, health-related quality of life and recovery of severity of PGP as assessed by the independent examiner. RESULTS: After treatment, median pain decreased from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group (P = 0.493) as assessed on a VAS. Women in the acupuncture group were in regular work to a higher extent than women in the sham group (n = 28/57 versus 16/57, P = 0.041). The acupuncture group had superior ability to perform daily activities measured with the disability rating index (DRI) (44 versus 55, P = 0.001). There were no significant differences in quality of life, discomfort of PGP and recovery from severity of PGP between the groups. CONCLUSIONS: Acupuncture had no significant effect on pain or on the degree of sick leave compared with non-penetrating sham acupuncture. There was some improvement in performing daily activities according to DRI. The data imply that needle penetration contributes to a limited extent to the previously reported beneficial effects of acupuncture.
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| 3. |
- Elden, Helen, 1959, et al.
(author)
-
Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369 women diagnosed with pelvic girdle pain during pregnancy
- 2013
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In: Advances in multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.. - 9789081601603
-
Conference paper (peer-reviewed)abstract
- Introduction PGP have been associated with muscular dysfunction, maternal factors, and pre-pregnancy low back pain, LBP, and/or pelvic girdle pain, PGP. It has also been stated that the pain and functional disturbances in relation to PGP must be reproducible by specific clinical tests. However, physical examinations have not been performed in long-time follow-ups of women with well-defined PGP during pregnancy and knowledge of potential predictors for long-standing LBP/PGP in these women is limited. Aim To describe the long-term development of back pain in women with well-defined PGP during pregnancy and, to identify potential predictors for persistent PGP and/or LBP in a long time perspective. Materials and Methods Women with well-defined PGP according to mechanical assessment of the, lumbar spine, pelvic pain provocation tests, standard history, pain drawings and European Guidelines who completed one of three treatment studies in 2000-2002, 2006-2007 or 2009-2011 answered a questionnaire. Women reporting pain from the pelvic girdle and/or lower back were physically examined. Results Of 534 eligible women, 380 (71%) answered the questionnaire. Data from 37 (9.7%) women were excluded from analysis due to pregnancy (n=15), systemic disease (n=11), participated in two of the studies (=n5) and declined examination (n=6). Forty-five women/343 (13%) had verified back pain. Of these women, 12/343 (3.5%) had LBP; 15/343 (4.4%) had PGP and 18/343 (5.2%) had combined back- and pelvic girdle pain. During pregnancy, predictors for persisting back pain were: Having a back pain history before pregnancy (p=0.0194), high pain intensity in the morning (Visual Analogue Scale, p=0.0097), impaired function (Oswestery Disability Index p=0.0127), low health related quality of life (Euro-qol, p=0.0097), use of an elastic pelvic belt (p=0.031), difficulty to turn over in bed (p=0.001) and early debut of PGP in pregnancy (p=0.029). Relevance of the number of positive pain provocation tests during pregnancy and at follow-up will also be presented. Relevance PGP can be physically compromising during pregnancy and cause anxiousness concerning childcare after delivery and later return to work and future work planning. It is therefore important to present a reliable prognosis to these women as early as possible, preferably during pregnancy. Discussion Considering the long follow up (10 years), the dropout-ratio in this study was acceptable and the results presented were in line with earlier publications about persistent LBP and PGP in a shorter perspective. Furthermore, the women were physically examined by skilled physiotherapists to confirm the diagnoses PGP and LBP in accordance with the European Guidelines. This increases the reliability of our findings, and we therefore believe that general conclusions can be drawn. A well founded prognosis for the later development of PGP and LBP found during pregnancy thus can be presented to the pregnant women covering the time from delivery up to a decade later. Conclusion: Most women (88%) with well-defined PGP during pregnancy recovered. The long time results confirm earlier short time findings that a back pain history before pregnancy, server PGP during pregnancy and early debut of PGP in pregnancy are risk factors for persisting pain several years postpartum. Implications Identification of women at risk for longstanding back pain seems possible in early pregnancy using physical examination and self-reports.
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| 4. |
- Elden, Helen, 1959, et al.
(author)
-
Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial
- 2005
-
In: Bmj. ; 330:7494, s. 761-764
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy. DESIGN: Randomised single blind controlled trial. Settings East Hospital, Gothenburg, and 27 maternity care centres in Sweden. PARTICIPANTS: 386 pregnant women with pelvic girdle pain. INTERVENTIONS: Treatment for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilising exercises (n = 131). MAIN OUTCOME MEASURES: Primary outcome measure was pain (visual analogue scale); secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner before and after treatment. RESULTS: After treatment the stabilising exercise group had less pain than the standard group in the morning (median difference = 9, 95% confidence interval 1.7 to 12.8; P = 0.0312) and in the evening (13, 2.7 to 17.5; P = 0.0245). The acupuncture group, in turn, had less pain in the evening than the stabilising exercise group (-14, -18.1 to -3.3; P = 0.0130). Furthermore, the acupuncture group had less pain than the standard treatment group in the morning (12, 5.9 to 17.3; P < 0.001) and in the evening (27, 13.3 to 29.5; P < 0.001). Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group. CONCLUSION: Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilising exercises in this study.
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| 5. |
- Elden, Helen, 1959, et al.
(author)
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Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial
- 2004
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In: The 5th Interdisciplinary World Congress on Low Back Pain & Pelvic Pain”, 2004, Melbourne.. - 9080255149
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Conference paper (peer-reviewed)abstract
- OBJECTIVES: To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy. DESIGN: Randomised single blind controlled trial. Settings East Hospital, Gothenburg, and 27 maternity care centres in Sweden. PARTICIPANTS: 386 pregnant women with pelvic girdle pain. INTERVENTIONS: Treatment for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilising exercises (n = 131). MAIN OUTCOME MEASURES: Primary outcome measure was pain (visual analogue scale); secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner before and after treatment. RESULTS: After treatment the stabilising exercise group had less pain than the standard group in the morning (median difference = 9, 95% confidence interval 1.7 to 12.8; P = 0.0312) and in the evening (13, 2.7 to 17.5; P = 0.0245). The acupuncture group, in turn, had less pain in the evening than the stabilising exercise group (-14, -18.1 to -3.3; P = 0.0130). Furthermore, the acupuncture group had less pain than the standard treatment group in the morning (12, 5.9 to 17.3; P < 0.001) and in the evening (27, 13.3 to 29.5; P < 0.001). Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group. CONCLUSION: Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilising exercises in this study.
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| 6. |
- Elden, Helen, 1959, et al.
(author)
-
Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: A multicentre, single blind, randomised controlled trial
- 2013
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:7, s. 775-782
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Journal article (peer-reviewed)abstract
- Objective. Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared to standard treatment alone for PGP during pregnancy. Design. Randomised, multicentre, single blind, controlled trial. Setting. University hospital, a private clinic and 26 maternity care centres in Gothenburg, Sweden. Population. 123 pregnant women with PGP. Methods. Participants were randomly assigned to standard treatment (control group, n=60) or standard treatment plus craniosacral therapy (intervention group, n=63). Main Outcome Measures. Primary outcome measures: Pain intensity (Visual Analogue Scale 0-100mm) and sick leave. Secondary outcomes: function (Oswestery Disability Index), health-related quality of life (Euro-Qol), unpleasantness of pain (VAS), and assessment of the severity of PGP by an independent examiner. Results. Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. VAS median was 27 mm (95%CI 24.6-35.9) vs. 35 mm (95%CI 33.5-45.7)(p=0.017) and the function disability index was 40 (range 34-46) vs. 48 (range 40-56)(p=0.016). Conclusions. Lower morning pain intensity and lesser deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared to standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before reccomending craniosacral therapy for pelvic girdle pain.
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| 7. |
- Elden, Helen, 1959, et al.
(author)
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Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study.
- 2016
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In: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
-
Journal article (peer-reviewed)abstract
- Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women's health and function up to 11years after pregnancy.A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP.A total of 371/530 (70%) women responded and 37/ 371 (10%) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR=1.79), history of low back pain (LBP) (OR=2.28), positive symphysis pressure test (OR=2.01), positive Faber (Patrick's) test (OR=2.22), and positive modified Trendelenburg test (OR=2.20). Women with PGP had significantly decreased ability to perform daily activities (p<.001), lower self-efficacy (p=0.046), decreased HRQL (p<.001), higher levels of anxiety and depression (p<.001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p=0.032) compared to women with no PGP.This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.
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| 8. |
- Elden, Helen, 1959, et al.
(author)
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Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities
- 2008
-
In: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 87:2, s. 201-8
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment was effective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown. The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. DESIGN: A randomised, single blind, controlled trial. SETTING: East Hospital and 27 maternity care centres in Göteborg, Sweden. POPULATION: Some 386 pregnant women with pelvic girdle pain. METHODS: Participants were randomly assigned to standard treatment plus acupuncture (n=125), standard treatment plus specific stabilising exercises (n=131) or to standard treatment alone (n=130). MAIN OUTCOME MEASURES: Primary outcome measures: pain intensity (Visual Analogue Scale). Secondary outcome measure: assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks after delivery. RESULTS: Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were no differences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle pain had resolved in 99% of the women 12 weeks after delivery. CONCLUSIONS: This study shows that irrespective of treatment modality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.
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| 9. |
- Elden, Helen, 1959, et al.
(author)
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Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities
- 2007
-
In: The 6th Interdiciplinary World Congress on Low Back Pain & Pelvic Pain, 2007 Barcelona.. - 9080255114
-
Conference paper (peer-reviewed)abstract
- OBJECTIVE: An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment was effective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown. The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. DESIGN: A randomised, single blind, controlled trial. SETTING: East Hospital and 27 maternity care centres in Göteborg, Sweden. POPULATION: Some 386 pregnant women with pelvic girdle pain. METHODS: Participants were randomly assigned to standard treatment plus acupuncture (n=125), standard treatment plus specific stabilising exercises (n=131) or to standard treatment alone (n=130). MAIN OUTCOME MEASURES: Primary outcome measures: pain intensity (Visual Analogue Scale). Secondary outcome measure: assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks after delivery. RESULTS: Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were no differences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle pain had resolved in 99% of the women 12 weeks after delivery. CONCLUSIONS: This study shows that irrespective of treatment modality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.
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| 10. |
- Elden, Helen, 1959, et al.
(author)
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Treatment Modalities for Pelvic Girdle Pain in Pregnant Women
- 2014
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In: Journal of Acupuncture and Meridian Studies. - : Medical Association of Pharmacopuncture Institute. - 2005-2901.
-
Conference paper (other academic/artistic)abstract
- Abstract Background: Pelvic girdle pain (PGP) affects 30 percent of pregnant women. It severely affects pregnant women’s daily lives and causes high costs for society. Methods: Two randomized controlled trials (RCT) compared the efficacies of (1) standard treatment (S) plus acupuncture (ACU), S þ stabilizing exercises (SE), and S alone (nZ386) and (2) penetrating acupuncture (PACU) and non-penetrating sham acupuncture (NPACU) as an adjunct to S in pregnant women (nZ115) with well-defined PGP. Results: ACU, as well as SE, constituted efficient complements to S for PGP during pregnancy. ACU had no observable severe adverse influences on the pregnancy, the mother, the delivery or the fetus/neonate. Regression of PGP after delivery was excellent. Both PACU and NPACU led to clinically relevant decreases in pain. Compared to the NPACU group, the PACU group had superior ability in 7 of 13 daily activities. Conclusion: ACU and SE as adjuncts to standard treatment are effective for treating PGP during pregnancy. Acupuncture is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Regression of PGP occurs in the great majority of women after delivery. PACU had no additional effect on PGP reduction compared to NPACU, but it improved the ability to perform daily activities, keeping more women in regular work. Keywords: pelvic girdle pain; acupuncture; stabilizing exercises; adverse events; regression
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| 11. |
- Elden, Helen, 1959, et al.
(author)
-
Treatmentmodalities for pelvic girdle pain during pregnancy
- 2010
-
In: NMAC, Nordisk akupunktur kongress , Aug 2010, Åland..
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Conference paper (peer-reviewed)abstract
- Pelvic girdle pain (PGP) affects about 20% of pregnant women. It causes great suffering for the individual and high costs for society. Persisting PGP have been reported in 10 to 75% three months after pregnancy and some women have also stated that PGP has been the beginning of a chronic condition. Risk factors for PGP are history of low back pain, history of PGP or trauma to the pelvis. Available evidence of research of treatment for the condition is insufficient to recommend any particular treatment modality for PGP. Also, the use of acupuncture for PGP is sparse due to insufficient documentation of adverse effects of this treatment in this specific condition. The main purpose of this thesis was to study efficacy, safety and post pregnancy effects of standard treatment, acupuncture and stabilising exercises given to pregnant women with PGP. Based on this knowledge, our ultimate aim is to increase our knowledge about treatment of PGP. METHODS: Paper I reports on a randomised single-blind trial comparing efficacy of standard treatment plus acupuncture, standard treatment plus stabilising exercises and standard treatment alone in 386 pregnant women with diagnosed PGP. Paper II is a follow up study of the original randomised trial in which adverse effects during pregnancy and delivery, influence on the mother, fetus, pregnancy and the pregnancy outcome are reported. Paper III describes regression of PGP during 12 weeks after pregnancy among these women. Paper IV reports on a double-blind randomised trial in which effects of penetrating acupuncture and non-penetrating sham acupuncture as adjunct to standard treatment are compared in 115 pregnant women with diagnosed PGP. The aim with this study was to investigate if specific treatment effects of penetrating acupuncture go beyond effects of non-specific effects and individual attention. RESULTS: Acupuncture as well as stabilising exercises as adjunct to standard treatment constituted efficient complements to standard treatment for the management of PGP during pregnancy. Acupuncture administered with a stimulation that may be considered strong lead to minor adverse complaints on the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/ neonate. Regression of PGP after delivery was excellent with no differences in recovery between the three treatment groups. Both penetrating acupuncture and non-penetrating sham acupuncture lead to clinically relevant decrease of median pain after treatment but there were no significant difference between groups. Those who had received penetrating acupuncture were in regular work to a higher extent than those women that received non-penetrating sham acupuncture. The penetrating acupuncture group had superior ability in 7 of 13 daily activities (dressing; outdoor walks; climbing stairs, standing bent over a sink; running; heavy work and lifting heavy objects) than the non-penetrating sham acupuncture group. CONCLUSION: We have shown that acupuncture and stabilizing exercises as adjunct to standard treatment are effective for PGP during pregnancy. Even if our study was of insufficient size to exclude negative effects on delivery, perinatal morbidity and mortality as well as on CTG the study result adds support to the view that acupuncture even with stimulation that may be considered as strong is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Even if more studies are required, our data provides the most comprehensive data reported to date. Our data suggest that irrespective of treatment modality, regression of PGP occurs in the great majority of women within 12 weeks after delivery. Penetrating acupuncture had no additional effect on PGP reduction compared to non-penetrating sham acupuncture but it improved the ability to perform daily activities keeping more women in regular work. Thus, the data imply that needle penetration contributes to the previously reported beneficial effects of acupuncture
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| 12. |
- Elden, Helen, 1959, et al.
(author)
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Treatmentmodalities for pelvic girdle pain during pregnancy
- 2009
-
In: Acupuncture in Medicine. ; 27:4
-
Conference paper (peer-reviewed)abstract
- Pelvic girdle pain (PGP) affects about 20% of pregnant women. It causes great suffering for the individual and high costs for society. Persisting PGP have been reported in 10 to 75% three months after pregnancy and some women have also stated that PGP has been the beginning of a chronic condition. Risk factors for PGP are history of low back pain, history of PGP or trauma to the pelvis. Available evidence of research of treatment for the condition is insufficient to recommend any particular treatment modality for PGP. Also, the use of acupuncture for PGP is sparse due to insufficient documentation of adverse effects of this treatment in this specific condition. The main purpose of this thesis was to study efficacy, safety and post pregnancy effects of standard treatment, acupuncture and stabilising exercises given to pregnant women with PGP. Based on this knowledge, our ultimate aim is to increase our knowledge about treatment of PGP. METHODS: Paper I reports on a randomised single-blind trial comparing efficacy of standard treatment plus acupuncture, standard treatment plus stabilising exercises and standard treatment alone in 386 pregnant women with diagnosed PGP. Paper II is a follow up study of the original randomised trial in which adverse effects during pregnancy and delivery, influence on the mother, fetus, pregnancy and the pregnancy outcome are reported. Paper III describes regression of PGP during 12 weeks after pregnancy among these women. Paper IV reports on a double-blind randomised trial in which effects of penetrating acupuncture and non-penetrating sham acupuncture as adjunct to standard treatment are compared in 115 pregnant women with diagnosed PGP. The aim with this study was to investigate if specific treatment effects of penetrating acupuncture go beyond effects of non-specific effects and individual attention. RESULTS: Acupuncture as well as stabilising exercises as adjunct to standard treatment constituted efficient complements to standard treatment for the management of PGP during pregnancy. Acupuncture administered with a stimulation that may be considered strong lead to minor adverse complaints on the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/ neonate. Regression of PGP after delivery was excellent with no differences in recovery between the three treatment groups. Both penetrating acupuncture and non-penetrating sham acupuncture lead to clinically relevant decrease of median pain after treatment but there were no significant difference between groups. Those who had received penetrating acupuncture were in regular work to a higher extent than those women that received non-penetrating sham acupuncture. The penetrating acupuncture group had superior ability in 7 of 13 daily activities (dressing; outdoor walks; climbing stairs, standing bent over a sink; running; heavy work and lifting heavy objects) than the non-penetrating sham acupuncture group. CONCLUSION: We have shown that acupuncture and stabilizing exercises as adjunct to standard treatment are effective for PGP during pregnancy. Even if our study was of insufficient size to exclude negative effects on delivery, perinatal morbidity and mortality as well as on CTG the study result adds support to the view that acupuncture even with stimulation that may be considered as strong is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Even if more studies are required, our data provides the most comprehensive data reported to date. Our data suggest that irrespective of treatment modality, regression of PGP occurs in the great majority of women within 12 weeks after delivery. Penetrating acupuncture had no additional effect on PGP reduction compared to non-penetrating sham acupuncture but it improved the ability to perform daily activities keeping more women in regular work. Thus, the data imply that needle penetration contributes to the previously reported beneficial effects of acupuncture
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| 13. |
- Elden, Helen, 1959, et al.
(author)
-
Treatmentmodalities for pelvic girdle pain during pregnancy.
- 2008
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In: SFOG (Svensk förening för obstetrik och gynekologi), 2008, Luleå..
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Conference paper (peer-reviewed)abstract
- Pelvic girdle pain (PGP) affects about 20% of pregnant women. It causes great suffering for the individual and high costs for society. Persisting PGP have been reported in 10 to 75% three months after pregnancy and some women have also stated that PGP has been the beginning of a chronic condition. Risk factors for PGP are history of low back pain, history of PGP or trauma to the pelvis. Available evidence of research of treatment for the condition is insufficient to recommend any particular treatment modality for PGP. Also, the use of acupuncture for PGP is sparse due to insufficient documentation of adverse effects of this treatment in this specific condition. The main purpose of this thesis was to study efficacy, safety and post pregnancy effects of standard treatment, acupuncture and stabilising exercises given to pregnant women with PGP. Based on this knowledge, our ultimate aim is to increase our knowledge about treatment of PGP. METHODS: Paper I reports on a randomised single-blind trial comparing efficacy of standard treatment plus acupuncture, standard treatment plus stabilising exercises and standard treatment alone in 386 pregnant women with diagnosed PGP. Paper II is a follow up study of the original randomised trial in which adverse effects during pregnancy and delivery, influence on the mother, fetus, pregnancy and the pregnancy outcome are reported. Paper III describes regression of PGP during 12 weeks after pregnancy among these women. Paper IV reports on a double-blind randomised trial in which effects of penetrating acupuncture and non-penetrating sham acupuncture as adjunct to standard treatment are compared in 115 pregnant women with diagnosed PGP. The aim with this study was to investigate if specific treatment effects of penetrating acupuncture go beyond effects of non-specific effects and individual attention. RESULTS: Acupuncture as well as stabilising exercises as adjunct to standard treatment constituted efficient complements to standard treatment for the management of PGP during pregnancy. Acupuncture administered with a stimulation that may be considered strong lead to minor adverse complaints on the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/ neonate. Regression of PGP after delivery was excellent with no differences in recovery between the three treatment groups. Both penetrating acupuncture and non-penetrating sham acupuncture lead to clinically relevant decrease of median pain after treatment but there were no significant difference between groups. Those who had received penetrating acupuncture were in regular work to a higher extent than those women that received non-penetrating sham acupuncture. The penetrating acupuncture group had superior ability in 7 of 13 daily activities (dressing; outdoor walks; climbing stairs, standing bent over a sink; running; heavy work and lifting heavy objects) than the non-penetrating sham acupuncture group. CONCLUSION: We have shown that acupuncture and stabilizing exercises as adjunct to standard treatment are effective for PGP during pregnancy. Even if our study was of insufficient size to exclude negative effects on delivery, perinatal morbidity and mortality as well as on CTG the study result adds support to the view that acupuncture even with stimulation that may be considered as strong is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Even if more studies are required, our data provides the most comprehensive data reported to date. Our data suggest that irrespective of treatment modality, regression of PGP occurs in the great majority of women within 12 weeks after delivery. Penetrating acupuncture had no additional effect on PGP reduction compared to non-penetrating sham acupuncture but it improved the ability to perform daily activities keeping more women in regular work. Thus, the data imply that needle penetration contributes to the previously reported beneficial effects of acupuncture
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| 14. |
- Elden, Helen, 1959, et al.
(author)
-
Treatmentmodalities for pelvic girdle pain during pregnancy
- 2007
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In: Riksstämman, 2007, Göteborg.
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Conference paper (peer-reviewed)abstract
- Pelvic girdle pain (PGP) affects about 20% of pregnant women. It causes great suffering for the individual and high costs for society. Persisting PGP have been reported in 10 to 75% three months after pregnancy and some women have also stated that PGP has been the beginning of a chronic condition. Risk factors for PGP are history of low back pain, history of PGP or trauma to the pelvis. Available evidence of research of treatment for the condition is insufficient to recommend any particular treatment modality for PGP. Also, the use of acupuncture for PGP is sparse due to insufficient documentation of adverse effects of this treatment in this specific condition. The main purpose of this thesis was to study efficacy, safety and post pregnancy effects of standard treatment, acupuncture and stabilising exercises given to pregnant women with PGP. Based on this knowledge, our ultimate aim is to increase our knowledge about treatment of PGP. METHODS: Paper I reports on a randomised single-blind trial comparing efficacy of standard treatment plus acupuncture, standard treatment plus stabilising exercises and standard treatment alone in 386 pregnant women with diagnosed PGP. Paper II is a follow up study of the original randomised trial in which adverse effects during pregnancy and delivery, influence on the mother, fetus, pregnancy and the pregnancy outcome are reported. Paper III describes regression of PGP during 12 weeks after pregnancy among these women. Paper IV reports on a double-blind randomised trial in which effects of penetrating acupuncture and non-penetrating sham acupuncture as adjunct to standard treatment are compared in 115 pregnant women with diagnosed PGP. The aim with this study was to investigate if specific treatment effects of penetrating acupuncture go beyond effects of non-specific effects and individual attention. RESULTS: Acupuncture as well as stabilising exercises as adjunct to standard treatment constituted efficient complements to standard treatment for the management of PGP during pregnancy. Acupuncture administered with a stimulation that may be considered strong lead to minor adverse complaints on the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/ neonate. Regression of PGP after delivery was excellent with no differences in recovery between the three treatment groups. Both penetrating acupuncture and non-penetrating sham acupuncture lead to clinically relevant decrease of median pain after treatment but there were no significant difference between groups. Those who had received penetrating acupuncture were in regular work to a higher extent than those women that received non-penetrating sham acupuncture. The penetrating acupuncture group had superior ability in 7 of 13 daily activities (dressing; outdoor walks; climbing stairs, standing bent over a sink; running; heavy work and lifting heavy objects) than the non-penetrating sham acupuncture group. CONCLUSION: We have shown that acupuncture and stabilizing exercises as adjunct to standard treatment are effective for PGP during pregnancy. Even if our study was of insufficient size to exclude negative effects on delivery, perinatal morbidity and mortality as well as on CTG the study result adds support to the view that acupuncture even with stimulation that may be considered as strong is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Even if more studies are required, our data provides the most comprehensive data reported to date. Our data suggest that irrespective of treatment modality, regression of PGP occurs in the great majority of women within 12 weeks after delivery. Penetrating acupuncture had no additional effect on PGP reduction compared to non-penetrating sham acupuncture but it improved the ability to perform daily activities keeping more women in regular work. Thus, the data imply that needle penetration contributes to the previously reported beneficial effects of acupuncture
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| 15. |
- Elden, Helen, 1959, et al.
(author)
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Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate
- 2008
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In: BMC complementary and alternative medicine. - : Springer Science and Business Media LLC. - 1472-6882. ; 8
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Journal article (peer-reviewed)abstract
- BACKGROUND: Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. METHODS: In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. RESULTS: There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. CONCLUSION: This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.
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| 16. |
- Gutke, Annelie, et al.
(author)
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Association between muscle function and low back pain in relation to pregnancy
- 2008
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 40:4, s. 304-311
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Journal article (peer-reviewed)abstract
- Objective: To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy. Design: Prospective cohort study. Subjects: Consecutively enrolled pregnant women seen in gestational weeks 12–18 (n = 301) and 3 months postpartum (n = 262). Methods: Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated. Results: In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001–0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain. Conclusion: Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.
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| 17. |
- Gutke, Annelie, et al.
(author)
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Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms
- 2011
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In: EUROPEAN SPINE JOURNAL. - : Springer Science Business Media. - 0940-6719 .- 1432-0932. ; 20:3, s. 440-448
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Journal article (peer-reviewed)abstract
- The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.
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| 18. |
- Gutke, Annelie, et al.
(author)
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Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning
- 2006
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In: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 31:5
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: A cohort study in pregnancy. OBJECTIVES: To differentiate between pregnancy-related pelvic girdle pain (PPGP) and lumbar pain, and to study the prevalence of each syndrome and its consequences in terms of pain, functioning, and health. SUMMARY OF BACKGROUND DATA: When studying prevalence, etiology, and consequences, differentiation between PPGP and lumbar pain is important, and, to our knowledge, its consequences for functioning and health during pregnancy have not previously been studied. METHODS: All women answered questionnaires (demographic data, EuroQol). Women with lumbopelvic pain completed the Oswestry Disability Index, pain intensity measures, in addition to undergoing a mechanical assessment of the lumbar spine, pain provocation tests, and active straight leg raising test. RESULTS: Of 313 women, 194 had lumbopelvic pain. The PPGP subgroup comprised 54% of those women with lumbopelvic pain, lumbar pain 17%, and combined PPGP and lumbar pain 29%. Women having both PPGP and lumbar pain reported the highest consequences in terms of health and functioning. CONCLUSIONS: Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.
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| 19. |
- Gutke, Annelie, 1967-
(author)
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Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The prevalence of low back pain (LBP) is higher in pregnant women compared to women of the same age in a general population. Pregnancy-related LBP persists 6 years after pregnancy in 16% of women. Consequently, pregnancy represents a specific risk for LBP and persistent LBP. Pregnancy-related LBP is usually studied as a single entity, however, only one subgroup of LBP, i.e. pelvic girdle pain (PGP), seems to be associated with pregnancy. Accordingly, possible differences in subgroups of patients with LBP are unknown.The aims of this thesis were the following: 1) to describe the prevalence of clinically classified subgroups of women with LBP in a cohort (no LBP, lumbar pain, PGP, and combined pain (PGP and lumbar pain)) during pregnancy and postpartum, and 2) to determine if there was a disparity in the course, health-related quality of life (HRQL), pain intensity, disability, depressive symptoms, or muscle function in subgroups of the cohort, and 3) to identify predictors for having persistent pregnancy-related PGP postpartum.Consecutively-enrolled pregnant women were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. All women answered questionnaires (background data, EQ-5D). Women with LBP completed the Oswestry Disability Index and pain measures. The Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum (cut-off ≥10). Trunk muscle endurance, hip muscle strength, and gait speed were investigated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.At the 12-18 gestational week evaluation, 118/308 (38%) women had no LBP, 33 (11%) had lumbar pain, 101 (33%) had PGP, and 56 (18%) had combined pain. Three months postpartum, 183/272 (67%) women had no LBP, 29 (11%) had lumbar pain, 46 (17%) had PGP, and 14 (5%) had combined pain. Pregnant women with combined pain were most affected in terms of HRQL, pain intensity, and disability. Depressive symptoms were three times more prevalent in women with LBP (27/87, 31%) than in women without LBP (17/180, 9%). Women with PGP and/or combined pain had lower values for trunk muscle endurance, hip extensor strength and gait speed compared to women without LBP. Postpartum, 16-20% of the women had persistent combined pain or PGP, whereas 1/29 had lumbar pain. Predictors for persistent PGP or combined pain were work dissatisfaction, older age, combined pain in early pregnancy, and low endurance of the back flexors.In conclusion, women with combined pain were identified to be a target group since they had the lowest recovery rate and since the classification of combined pain was found to be a predictor for persistent PGP or combined pain postpartum. The hypothesis of an association between muscle dysfunction and PGP was strengthened. Based on the finding of high comorbidity of postpartum depressive symptoms and LBP, it seems important to screen for and consider treatment strategies for both symptoms.
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| 20. |
- Gutke, Annelie, et al.
(author)
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Predicting persistent pregnancy-related low back pain
- 2008
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In: Spine. - 0362-2436 .- 1528-1159. ; 33:12, s. E386-E393
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Journal article (peer-reviewed)abstract
- Objective: To examine the course of subtypes of low back pain (LBP) experienced [no LBP, pelvic girdle pain (PGP), lumbar pain, and combined PGP and lumbar pain (combined pain)] during gestational weeks 12 to 18 and 3 months postpartum, and to explore potential predictors for persistent PGP or combined pain postpartum. Summary of background data: LBP is more prevalent in pregnant women (25%) than in the general population (6.3%). Persistent LBP postpartum (16%) is usually studied as a single entity. However, only one subgroup of LBP, pelvic girdle pain (PGP), is associated with pregnancy. Several studies have suggested an association between muscular dysfunction and pregnancy-related LBP, however, muscle dysfunction has not been evaluated as potential predictor of persistent LBP postpartum. Possible subgroup differences in the course and predictors of persistent LBP are unknown. Methods: Pregnant women (n = 308) were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were evaluated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination. Results: Women with combined pain recovered to a lower degree 33% (17 of 51) than those with PGP 66% (56 of 85) or lumbar pain 72% (21 of 29). Predictors for having persistent PGP or combined pain after delivery were low endurance of back flexors, older age, combined pain in early pregnancy and work dissatisfaction (explained variance 30%). Conclusion: Women with combined pain were identified to be a target group since they had the most unfavorable course and since the classification of combined pain was found to be a predictor for persistent pain postpartum. Identification of women at risk for persistent pain postpartum seems possible in early pregnancy and requires physical examination and self-reports. Pregnancy had low impact on the course of lumbar pain.
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| 21. |
- Gutke, Annelie, et al.
(author)
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Untitled - Response
- 2006
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In: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 31:20, s. 2406-2407
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Journal article (other academic/artistic)
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| 22. |
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| 23. |
- Limbäck Svensson, Gunilla, et al.
(author)
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High degree of kinesiophobia after lumbar disc herniation surgery.
- 2011
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In: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 82:6, s. 732-736
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Journal article (peer-reviewed)abstract
- Background and purpose Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. Patients and methods 10?34 months after surgery, questionnaires were sent to 97 patients who had undergone standardized open discectomy. Outcome measures included Tampa scale for kinesiophobia (TSK); Oswestry disability index (ODI); European quality of life in 5 dimensions (EQ-5D); visual analog scale (VAS) for leg and back pain, work disability, and patient satisfaction; Zung self-rating depression scale (ZDS); pain catastrophizing scale (PCS); and a self-efficacy scale (SES). Results 36 of 80 patients reported having kinesiophobia. There were statistically significant differences in ODI, EQ-5D, VAS leg and back pain, ZDS, PCS, and SES between patients with and without kinesiophobia. Interpretation Half of the patients suffered from kinesiophobia 10?34 months after surgery for disc herniation. These patients were more disabled, had more pain, more catastrophizing thoughts, more symptoms of depression, lower self-efficacy, and poorer health-related quality of life than patients without kinesiophobia.
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| 24. |
- Vleeming, A., et al.
(author)
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European guidelines for the diagnosis and treatment of pelvic girdle pain
- 2008
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In: European Spine Journal. - : Springer Science and Business Media LLC. - 1432-0932 .- 0940-6719. ; 17:6, s. 794-819
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Journal article (peer-reviewed)abstract
- A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.
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| 25. |
- Wu, W. H., et al.
(author)
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Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence
- 2004
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In: Eur Spine J. - : Springer Science and Business Media LLC. - 0940-6719. ; 13:7, s. 575-89
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Journal article (peer-reviewed)abstract
- Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose "pregnancy-related pelvic girdle pain (PPP)", and "pregnancy-related low back pain (PLBP)", present evidence that the two add up to "lumbopelvic pain", and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.
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